Mitral stenosis stages: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{CMG}} | {{CMG}} {{AE}} {{S.G.}} | ||
{{Mitral stenosis}} | |||
==Overview== | ==Overview== | ||
According to the 2014 [[American Heart Association|AHA]]/[[ACC]] [[Guidelines International Network|guidelines]] for management of [[Valvular heart disease|valvular heart diseases]] and [[valve]] [[morphology]], the [[valve]] [[hemodynamics]] characteristics, the consequences of MS on the [[left atrium]] and the [[pulmonary]] [[arterial]] [[system]], and base on the presence or absence of [[Symptom|symptoms]], there are 4 stages of mitral stenosis. Staging of mitral stenosis (MS) is of utmost importance because it dictates the appropriate management plan for the affected [[Patient|patients]]. | |||
==Stages of Mitral Stenosis== | ==Stages of Mitral Stenosis== | ||
<span style="font-size:85%">'''MS:''' | == 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines<ref name="pmid33332150">{{cite journal| author=Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F | display-authors=etal| title=2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2021 | volume= 143 | issue= 5 | pages= e72-e227 | pmid=33332150 | doi=10.1161/CIR.0000000000000923 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33332150 }}</ref> == | ||
=== Table 16. Stages of MS === | |||
{| class="wikitable" | |||
|- | |||
| style="background:#DCDCDC;" |'''Stage'''|| style="background:#DCDCDC;" |'''Definition'''|| style="background:#DCDCDC;" |'''[[Valve]] [[anatomy]]'''|| style="background:#DCDCDC;" |'''[[Valve]] [[hemodynamics]]'''|| style="background:#DCDCDC;" |'''[[Hemodynamic]] [[Consequence operator|consequences]]'''|| style="background:#DCDCDC;" |'''[[Symptom|Symptoms]]''' | |||
|- | |||
|'''A'''||At risk of MS||❑ Mild [[Diastole|diastolic]] doming of [[mitral valve]] leaflets||❑ Normal transmitral velocity||None||None | |||
|- | |||
|'''B'''||Progressive MS|| ❑ Rheumatic valve changes with commissural fusion and diastolic doming of the mitral valve leaflets Planimetered mitral valve area >1.5 cm2||❑ Increased transmitral flow velocities<br>❑Mitral valve area >1.5 cm<sup>2</sup><br>❑ Diastolic pressure half-time <150 ms||❑ Mild to moderate [[left atrial]] enlargement<br>❑ Normal [[pulmonary]] [[pressure]] at rest ||None | |||
|- | |||
|'''C'''||[[Asymptomatic]] severe MS||❑ [[Rheumatology|Rheumatic]] [[valve]] changes characterized by commissural fusion and [[Diastole|diastolic]] doming of [[mitral valve]]<br> ❑ Planimetered mitral valve area ≤1.5 cm<sup>2</sup><br>|| ❑ Mitral valve area ≤1.5 cm<sup>2</sup><br>❑ Diastolic pressure half-time ≥150 ms||❑ Severe [[left atrial]] enlargement<br>❑ Elevated PASP >50 mm Hg||None | |||
|- | |||
|'''D'''||[[Symptomatic]] severe MS||❑ [[Rheumatology|Rheumatic]] [[valve]] changes characterized by [[Commissural fibers|commissural]] fusion and [[Diastole|diastolic]] doming of [[mitral valve]]<br> ❑ Planimetered mitral valve area ≤1.5 cm<sup>2</sup>||❑ Mitral valve area ≤1.5 cm<sup>2</sup><br>❑ Diastolic pressure half-time ≥150 ms||❑ Severe [[Left atrium|left atrial]] enlargement<br>❑ PASP > 50 [[MmHg|mm Hg]]||❑Decreased exercise tolerance<br>❑ Exertional dyspnea | |||
|} | |||
The transmitral mean pressure gradient should be obtained to further determine the hemodynamic effect of the MS and is usually >5 mm Hg to 10 mm Hg in severe MS; however, because of the variability of the mean pressure gradient with heart rate and forward flow, it has not been included in the criteria for severity.LA indicates left atrial; MS, mitral stenosis; and PASP, pulmonary artery systolic pressure. | |||
According to the 2014 [[American Heart Association|AHA]]/[[ACC]] [[Guidelines International Network|guidelines]] for management of [[Valvular heart disease|valvular heart diseases]] and [[valve]] [[morphology]], the [[valve]] [[hemodynamics]] characteristics, the consequences of MS on the [[left atrium]] and the [[pulmonary]] [[arterial]] [[system]], and base on the presence or absence of [[Symptom|symptoms]], there are 4 stages of mitral stenosis.<ref name="NishimuraOtto2014">{{cite journal|last1=Nishimura|first1=Rick A.|last2=Otto|first2=Catherine M.|last3=Bonow|first3=Robert O.|last4=Carabello|first4=Blase A.|last5=Erwin|first5=John P.|last6=Guyton|first6=Robert A.|last7=O’Gara|first7=Patrick T.|last8=Ruiz|first8=Carlos E.|last9=Skubas|first9=Nikolaos J.|last10=Sorajja|first10=Paul|last11=Sundt|first11=Thoralf M.|last12=Thomas|first12=James D.|title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary|journal=Circulation|volume=129|issue=23|year=2014|pages=2440–2492|issn=0009-7322|doi=10.1161/CIR.0000000000000029}}</ref> | |||
Shown below is a table depicting the 4 stages of mitral stenosis, adapted from 2014 [[AHA/ASA guidelines for the management of spontaneous intracerebral hemorrhage|AHA]]/[[ACC]] [[Medical guideline|guidelines]] for management of [[Valvular heart disease|valvular heart diseases]].<ref name="pmid24589852">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2014 | volume= | issue= | pages= | pmid=24589852 | doi=10.1161/CIR.0000000000000029 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24589852 }} </ref> | |||
<span style="font-size:85%">'''Abbreviations:''' '''MS: ''' mitral stenosis; '''MVA: '''[[mitral valve]] area; '''PASP: ''' [[pulmonary]] [[artery]] [[Systolic blood pressure|systolic pressure]]</span> | |||
{|Class="wikitable" | {|Class="wikitable" | ||
|- | |- | ||
|style="background:#DCDCDC;"|''' | |style="background:#DCDCDC;"|'''Stage'''||style="background:#DCDCDC;"|'''Definition'''||style="background:#DCDCDC;"|'''[[Valve]] [[anatomy]]'''||style="background:#DCDCDC;"|'''[[Valve]] [[hemodynamics]]'''||style="background:#DCDCDC;"|'''[[Hemodynamic]] [[Consequence operator|consequences]]'''||style="background:#DCDCDC;"|'''[[Symptom|Symptoms]]''' | ||
|- | |- | ||
|'''A'''||At risk of | |'''A'''||At risk of MS||❑ Mild [[Diastole|diastolic]] doming of [[mitral valve]] leaflets||❑ Normal transmitral velocity||Absent||Absent | ||
|- | |- | ||
|'''B'''||Progressive | |'''B'''||Progressive MS|| ❑ [[Rheumatic]] [[valve]] changes characterized by commissural fusion and diastolic doming of [[mitral valve]]<br>❑ MVA > 1.5 [[Centimetre|cm<sup>2</sup>]] (planimetered)||❑ Increased transmitral flow velocities<br>❑ [[MVA]] > 1.5 [[Centimetre|cm<sup>2</sup>]] <br>❑ [[Pressure]] half time during [[diastole]] < 150 ms||❑ Mild to moderate [[left atrial]] enlargement<br>❑ Normal [[pulmonary]] [[pressure]] at rest ||Absent | ||
|- | |- | ||
|'''C'''|| | |'''C'''||[[Asymptomatic]] severe MS||❑ [[Rheumatology|Rheumatic]] [[valve]] changes characterized by commissural fusion and [[Diastole|diastolic]] doming of [[mitral valve]]<br> ❑ MVA ≤ 1.5 [[Centimetre|cm<sup>2</sup>]]<br>❑ MVA ≤ 1 [[Centimetre|cm<sup>2</sup>]] in very severe [[MS]]|| ❑ MVA ≤ 1.5 [[Centimetre|cm<sup>2</sup>]] (planimetered)<br>❑ MVA ≤ 1 [[Centimetre|cm<sup>2</sup>]] (planimetered) in very severe [[MS]]<br>❑ [[Diastole|Diastolic]] [[pressure]] half time ≥ 150 ms<br> ❑ [[Diastole|Diastolic]] [[pressure]] half time ≥ 220 ms with very severe [[MS]]||❑ Severe [[left atrial]] enlargement<br>❑ PASP > 30 [[MmHg|mm Hg]]||Absent | ||
|- | |- | ||
|'''D'''|| | |'''D'''||[[Symptomatic]] severe MS||❑ [[Rheumatology|Rheumatic]] [[valve]] changes characterized by [[Commissural fibers|commissural]] fusion and [[Diastole|diastolic]] doming of [[mitral valve]]<br> ❑ MVA ≤ 1.5 [[Centimetre|cm<sup>2</sup>]] (planimetered)||❑ MVA ≤ 1.5 [[Centimetre|cm<sup>2</sup>]]<br>❑ MVA ≤ 1 [[Centimetre|cm<sup>2</sup>]] in very severe [[MS]]<br>❑ [[Diastole|Diastolic]] [[pressure]] half time ≥ 150 ms<br> ❑ [[Diastole|Diastolic]] [[pressure]] half time ≥ 220 ms with very severe [[MS]]||❑ Severe [[Left atrium|left atrial]] enlargement<br>❑ PASP > 30 [[MmHg|mm Hg]]||❑ [[Dyspnea]] on exertion<br>❑ Decreased [[exercise]] [[tolerance]] | ||
|} | |} | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 01:09, 7 December 2022
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2]
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Overview
According to the 2014 AHA/ACC guidelines for management of valvular heart diseases and valve morphology, the valve hemodynamics characteristics, the consequences of MS on the left atrium and the pulmonary arterial system, and base on the presence or absence of symptoms, there are 4 stages of mitral stenosis. Staging of mitral stenosis (MS) is of utmost importance because it dictates the appropriate management plan for the affected patients.
Stages of Mitral Stenosis
2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[1]
Table 16. Stages of MS
| Stage | Definition | Valve anatomy | Valve hemodynamics | Hemodynamic consequences | Symptoms |
| A | At risk of MS | ❑ Mild diastolic doming of mitral valve leaflets | ❑ Normal transmitral velocity | None | None |
| B | Progressive MS | ❑ Rheumatic valve changes with commissural fusion and diastolic doming of the mitral valve leaflets Planimetered mitral valve area >1.5 cm2 | ❑ Increased transmitral flow velocities ❑Mitral valve area >1.5 cm2 ❑ Diastolic pressure half-time <150 ms |
❑ Mild to moderate left atrial enlargement ❑ Normal pulmonary pressure at rest |
None |
| C | Asymptomatic severe MS | ❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of mitral valve ❑ Planimetered mitral valve area ≤1.5 cm2 |
❑ Mitral valve area ≤1.5 cm2 ❑ Diastolic pressure half-time ≥150 ms |
❑ Severe left atrial enlargement ❑ Elevated PASP >50 mm Hg |
None |
| D | Symptomatic severe MS | ❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of mitral valve ❑ Planimetered mitral valve area ≤1.5 cm2 |
❑ Mitral valve area ≤1.5 cm2 ❑ Diastolic pressure half-time ≥150 ms |
❑ Severe left atrial enlargement ❑ PASP > 50 mm Hg |
❑Decreased exercise tolerance ❑ Exertional dyspnea |
The transmitral mean pressure gradient should be obtained to further determine the hemodynamic effect of the MS and is usually >5 mm Hg to 10 mm Hg in severe MS; however, because of the variability of the mean pressure gradient with heart rate and forward flow, it has not been included in the criteria for severity.LA indicates left atrial; MS, mitral stenosis; and PASP, pulmonary artery systolic pressure.
According to the 2014 AHA/ACC guidelines for management of valvular heart diseases and valve morphology, the valve hemodynamics characteristics, the consequences of MS on the left atrium and the pulmonary arterial system, and base on the presence or absence of symptoms, there are 4 stages of mitral stenosis.[2]
Shown below is a table depicting the 4 stages of mitral stenosis, adapted from 2014 AHA/ACC guidelines for management of valvular heart diseases.[3]
Abbreviations: MS: mitral stenosis; MVA: mitral valve area; PASP: pulmonary artery systolic pressure
| Stage | Definition | Valve anatomy | Valve hemodynamics | Hemodynamic consequences | Symptoms |
| A | At risk of MS | ❑ Mild diastolic doming of mitral valve leaflets | ❑ Normal transmitral velocity | Absent | Absent |
| B | Progressive MS | ❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of mitral valve ❑ MVA > 1.5 cm2 (planimetered) |
❑ Increased transmitral flow velocities ❑ MVA > 1.5 cm2 ❑ Pressure half time during diastole < 150 ms |
❑ Mild to moderate left atrial enlargement ❑ Normal pulmonary pressure at rest |
Absent |
| C | Asymptomatic severe MS | ❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of mitral valve ❑ MVA ≤ 1.5 cm2 ❑ MVA ≤ 1 cm2 in very severe MS |
❑ MVA ≤ 1.5 cm2 (planimetered) ❑ MVA ≤ 1 cm2 (planimetered) in very severe MS ❑ Diastolic pressure half time ≥ 150 ms ❑ Diastolic pressure half time ≥ 220 ms with very severe MS |
❑ Severe left atrial enlargement ❑ PASP > 30 mm Hg |
Absent |
| D | Symptomatic severe MS | ❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of mitral valve ❑ MVA ≤ 1.5 cm2 (planimetered) |
❑ MVA ≤ 1.5 cm2 ❑ MVA ≤ 1 cm2 in very severe MS ❑ Diastolic pressure half time ≥ 150 ms ❑ Diastolic pressure half time ≥ 220 ms with very severe MS |
❑ Severe left atrial enlargement ❑ PASP > 30 mm Hg |
❑ Dyspnea on exertion ❑ Decreased exercise tolerance |
References
- ↑ Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F; et al. (2021). "2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 143 (5): e72–e227. doi:10.1161/CIR.0000000000000923. PMID 33332150 Check
|pmid=value (help). - ↑ Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Circulation. 129 (23): 2440–2492. doi:10.1161/CIR.0000000000000029. ISSN 0009-7322.
- ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852.